Resolution of warfarin-induced alopecia with conversion to apixaban

Warfarin is frequently prescribed as a long-term anticoagulant in patients with end-stage kidney disease as direct oral anticoagulants undergo renal excretion. Anticoagulation is a rare cause of alopecia in adults and is thought to be due to the promotion of the ‘resting phase’ of hair follicles. In...

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Bibliographic Details
Published in:BMJ case reports 2021-03, Vol.14 (3), p.e240579
Main Authors: Hull, Katherine Leigh, Gooding, Richard, Burton, James O
Format: Article
Language:English
Subjects:
Administration, Oral
Adult
Alopecia
Alopecia - chemically induced
Alopecia - drug therapy
Anticoagulants
Anticoagulants - adverse effects
Atrial Fibrillation - drug therapy
Baldness
Blood clots
Case Report
Case reports
Catheters
Chronic illnesses
Female
Hair loss
Hematology
Hemodialysis
Humans
Kidney diseases
Patients
Pyrazoles
Pyridones - adverse effects
Quality of Life
Thrombosis
Thyroid gland
Warfarin - adverse effects
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Summary:Warfarin is frequently prescribed as a long-term anticoagulant in patients with end-stage kidney disease as direct oral anticoagulants undergo renal excretion. Anticoagulation is a rare cause of alopecia in adults and is thought to be due to the promotion of the ‘resting phase’ of hair follicles. In this case report, a prevalent haemodialysis female patient required long-term anticoagulation following a complex pulmonary embolus and dialysis access complications. After commencing warfarin therapy, the patient reported generalised loss and thinning of her hair. All other potential causes were excluded. Cessation of warfarin therapy and conversion to apixaban with close monitoring alleviated the hair loss. Warfarin therapy is a rare cause of alopecia but should be considered in patients on long-term anticoagulation when other diagnoses have been excluded. Hair loss has a profoundly negative impact on patient quality of life and should prompt investigation to determine the underlying cause.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2020-240579